Thank you, Deputy Presiding Officer. I’m pleased to update Members on how NHS Wales, local authorities and other partners are planning to deliver resilient services to citizens for the coming winter period.

Last winter, urgent and emergency services experienced days where there were significant surges in demand, especially from patients with increasingly complex care needs. On some days, these peaks were above what could be realistically anticipated for emergency ambulances, primary care out-of-hours and, indeed, emergency admissions to hospital through accident and emergency departments. For example, at the turn of the year, the number of ambulance arrivals at A&E departments reached a peak of 22 per cent higher than the January 2015 average, and A&E attendances were up to 23 per cent higher than the January 2015 average.

Pressure on the care system is now recognised as a year-round reality, and yet the overwhelming experience is that our front-line staff continue to provide care with professionalism and compassion. I am sure everyone in the Chamber will join me in expressing appreciation for our dedicated staff, who help people when they need it the most.

This year, we instructed NHS Wales and local authorities to develop integrated plans earlier than before to jointly design their response to the challenges that winter will inevitably bring. The NHS and partners held a series of national planning events where key staff scrutinised plans to share learning from previous winters and examples of best practice.

In recent years, we’ve seen an increase in the resilience of our system by developing a whole-system approach, so planning and organisations together have built upon the plans and experiences of the last year to prepare for this winter. There are, of course, a range of positive actions planned to further improve resilience, including an increase in bed capacity, given the likely rise in the number of patients with multiple conditions who will require admission to a hospital. We’ll see strengthening of emergency ambulatory care services to enable patients with specific conditions to be treated without needing to stay in hospital overnight, wherever possible. And we’ve seen an overall downward trend in delayed transfers of care, and regional partnerships are actively working to achieve further improvements.

Maintaining good patient flow across the whole system is key, and there’s a strong focus on expediting discharge by maximizing our capacity through collaboration. Other areas to strengthen in readiness for this winter include additional step-up and step-down services across Wales to provide short-stay beds for people coming out of hospital who are medically fit, but not ready yet to return home. And those beds will also be used as a step-up for people in the community to avoid a hospital admission. All health boards plan to increase consultant cover over the challenging weekend periods, and that will include focusing the presence of senior decision makers over the weekend, for example, at the front door or on in-patient wards to help support the timely discharge of patients. There will be additional support for primary care out-of-hours services and improved use of social workers in hospital to expedite assessment and discharge, to name but a few.

But we also expect to learn from the past, and I am keen for new models of care to be implemented widely to support the needs of patients. I have been impressed by a wide range of innovative approaches, for example, the award-winning ‘bridging the gap’ initiative, which is an integrated approach in the Cardiff area, focusing on supporting patients who regularly attend A&E or call an ambulance, to help improve outcomes and reduce demand; the Môn enhanced care model in Anglesey, which delivers intensive care in the home for acutely ill elderly patients through community resource team working, the key partners being social care, advanced nurse practitioners and GPs; and the western bay community services programme in Swansea, which is a multi-disciplinary team again, aimed at improving access to intermediate care services and keeping people well and independent. Finally, I’m really pleased to say that the 111 pathfinder pilot commenced in the Abertawe Bro Morgannwg University Local Health Board in October and it provides a real opportunity to signpost patients to the right service.

We’ve supported our health and social care services to deliver safe and timely services over the winter and beyond with significant investment, and we have made tangible improvements. Of course, on 3 November, I announced that this Government has provided an extra £50 million for NHS Wales to help manage demand over the winter and support NHS performance. That is in addition to £3.8 million to support a national programme of pathfinders and pacesetter projects to test new and innovative ways of planning, organising and delivering primary care services, and £10 million comes from the national primary care fund to support the development of primary care clusters. That means an extra 250 additional primary care posts, including GPs, nursing posts, physiotherapists, occupational therapists and pharmacists to name but a few. We’ve also made £60 million available through the intermediate care fund for this year to help prevent unnecessary hospital admissions and delays in discharge. All of these Welsh Government initiatives are making tangible improvements to the delivery of services for people.

Importantly, thinking back to last year, our ambulance service this year is in a much better position heading into the winter, following a sustained improvement in performance over the last year. The latest information shows the average response time to immediately life-threatened patients is just four minutes and 38 seconds.

For the first time in a single year, we’ve seen over 1 million A&E attendances and this demand, combined with our ageing population and an increase in patients with complex needs, presents a real pressure within our system. Similar pressures are seen right across the NHS family within the UK. There is, of course, much more to be done to deliver the improvements that we want to see, but we have seen general improvements in performance against key emergency care access targets over the last six months. Of course, we can all play our part as citizens to help the NHS through increasing the take-up of free flu vaccines for those eligible and carefully considering whether a pharmacist is the best option when we do feel under the weather.

Finally, of course, we are urging people to ‘Choose Well’ this winter by keeping themselves warm. That will help prevent colds, flu or more serious health conditions such as heart attacks, strokes, pneumonia or depression. All of us recognise that winter is a challenging time for health and social care. We’ve seen successive years of rising demand that will continue to challenge the entire system, and that reinforces the need for a whole-system approach. No-one should pretend that winter will be easy, but I firmly believe the extensive local and national preparation will deliver robust, resilient services so that people have access to the care they require when they need it.